Public health ethics manages respect for patient autonomy with discrimination free environments. Unfortunately, situations arise which make it challenging to emphasize both. One example is when a patient requests a clinician of a specific race. This forces a choice of commitment between spaces free of discrimination and patient autonomy. The proper ethical response to this dilemma is as an institution to deny these requests, while still offering race-blind service.
There are several values to consider when determining the correct institutional responses to problems, the first being honesty. Institutions should act honestly in assessing their tradeoffs, being careful not to mislead patients or doctors. For instance, if a patient requests a doctor of a specific race before being put under anesthetic, they shouldn’t be misled to obtain consent. According to an ethics examination from the St. Vincent Health System, “A competent patient has the right to refuse medical treatment. This right is grounded in constitutional liberty interests and the doctrine of informed consent. It seems self-evident that this right would extend to refusing treatment from a particular provider.” Failing to answer patient questions honestly would be undermining their effective right of informed consent. However, details of no medical significance need not be volunteered if not asked for. This aspect of patient response balances their rights without unduly burdening the healthcare provider.
Another aspect to consider is the oath doctors take to treat all patients equally. This creates an ethical obligation to treat people from all backgrounds, regardless of whether the individual is an upstanding member of a given community. The important advantage of this universal obligation is that resources which would be spent judging morality could instead be used to heal the sick. This notion of universalism has been shown to override certain aspects of a doctor’s personal beliefs. The AMA Council on Ethical and Judicial Affairs deemed it unethical to refuse to treat patients diagnosed with HIV. Furthermore, under the Emergency Medical Treatment and Active Labor Act of 1987, hospitals participating in Medicare must stabilize and provide medical screening regardless of a patient’s ability to pay. This does not extend to providing all services. For instance, doctors are not required to perform abortions if they do not believe in doing so. Doctors should have choice about which services they provide, but they must serve everyone within that range. This stance manages to emphasize the ability for doctors to refuse patients medically irrelevant demands while also preventing discrimination. When a patient asks for a racial preference in clinicians, institutions can deny the racial aspect of the request but still must offer the medically relevant services.
The interests of the doctor are also an important factor. Doctors have the right to expect, like other professions, a workplace free of harassment and discrimination. In situations where the patient attempts to discriminate against the doctor, the right approach is not always clear. On one hand, asking a doctor to care for a patient who harasses them creates a hostile working environment. On the other hand, accommodating requests of a racial nature may create a segregated and racialized workplace. Honesty is important between the employer and employee as well. Hospitals should communicate with staff when there is something they should be aware of, including patients with racial preferences. Given burnout is already an issue in the medical profession, the chance for doctors to protect themselves against harassment or mentally prepare to receive it returns the autonomy which would have otherwise been robbed from them.
This approach is also among the more efficient ways of allocating healthcare. Accepting racial preferences in clinicians will create shortages and excesses of available clinicians, creating deadweight loss. Most hospital systems do not have the spare resources to fulfill these requests in the first place and accepting these requests would inefficiently use available doctors. Making the limitations of patient requests clear at the offset protects doctors from the unnecessary stress of bringing their creed into the workplace.
Other approaches may disagree with this balancing of ethical responsibilities and tilt more in favor of the interests of either doctors or patients. For instance, patients of OB/GYN are typically allowed to request women because of the intimate nature of this field of medicine and frequency of trauma caused by sexual misconduct. Some may go further and argue that not all racial preferences are caused by bigotry. African Americans worried about medical discrimination, or immigrants who prefer someone similar are in a different category from those who view certain races as less than. Ethical dilemmas tend to be nuanced. Despite any benefits to patients which come with these non-bigoted racial preferences, resources cannot be allocated to this cause efficiently. The scarcity of doctors and threat of enabling racism also provide reason to believe that institutions cannot be tasked with assignments based upon race. Fortunately, not all healthcare providers are part of large institutions, and may be able to serve the needs of specialized cases.
Another perspective may claim that this stance would be too lenient to racism; that doctor should have no obligation to service these individuals and perpetuate a hostile environment. Employment ought to be an oasis that shields from the effects of racism. This perspective seems overly punitive. Although trying to combat racism is an important goal, it is not the only goal of a medical establishment. Denying someone the ability to obtain healthcare sometimes means killing a person. Broadly speaking, people become doctors to save lives. It will go against the mission of medicine if institutions refuse to treat all undesirable people. Furthermore, I think my stance gives the needed space and support for medical professionals but maintains the interests of the patients.
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